Endoscopy 2019; 51(04): S80
DOI: 10.1055/s-0039-1681405
ESGE Days 2019 oral presentations
Friday, April 5, 2019 17:00 – 18:30: IBD Club A
Georg Thieme Verlag KG Stuttgart · New York

MAGNIFICATION ENDOSCOPY WITH OPTICAL CHROMOENDOSCOPY FOR THE IN VIVO ASSESSMENT OF HISTOLOGIC INFLAMMATION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

E Klenske
1   Department of Medicine 1, University Hospital of Erlangen, Erlangen, Germany
,
R Atreya
1   Department of Medicine 1, University Hospital of Erlangen, Erlangen, Germany
,
A Hartmann
2   Institute of Pathology, University Hospital of Erlangen, Erlangen, Germany
,
S Fischer
1   Department of Medicine 1, University Hospital of Erlangen, Erlangen, Germany
,
S Hirschmann
1   Department of Medicine 1, University Hospital of Erlangen, Erlangen, Germany
,
S Zundler
1   Department of Medicine 1, University Hospital of Erlangen, Erlangen, Germany
,
M Iacucci
3   Institute of Translational Medicine, University of Birmingham, Birmingham, United Kingdom
,
M Neurath
1   Department of Medicine 1, University Hospital of Erlangen, Erlangen, Germany
,
T Rath
1   Department of Medicine 1, University Hospital of Erlangen, Erlangen, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

 

Aims:

Apart from mucosal healing as an established treatment goal in inflammatory bowel diseases (IBD), recent evidence suggests that histologic healing is another key prognostic parameter in IBD patients. Herein we aimed to evaluate whether magnification endoscopy in combination with optical chromoendoscopy can accurately assess histologic inflammation in IBD patients.

Methods:

In this prospective study, 82 IBD patients (30 UC, 52 CD) were included. The in vivo histologic inflammation was made with magnification endoscopy in combination with optical chromoendoscopy by three independent endoscopists using a novel magnification score. Targeted biopsies of the imaged areas were obtained and results were compared against two histological scores in UC (Robarts Histopathology Index, RHI; Nancy Histology Index, NHI) and one score in CD (modified Riley index, mRI). Moreover, interobserver agreement was calculated.

Results:

Magnification endoscopy evaluating inflammatory activity based on the mucosal and vascular pattern showed strong correlation with histopathologic scoring in both UC (RHI: r = 0.83, NHI: r = 0.78, both p < 0.05) and CD (mRI: r = 0.74, p < 0.05) with high accuracy, sensitivity and specificity for assessing the histologic inflammation. Further, 25% of patients with mucosal healing on standard endoscopy showed signs of microinflammation on magnification endoscopy in combination with optical chromoendoscopy while none of the patients with mucosal and vascular healing under magnification endoscopy in combination with optical chromoendoscopy exhibited microscopic inflammation. Interobserver agreement for grading intestinal inflammation by magnification endoscopy with optical chromoendoscopy was substantial (κ > 0.7).

Conclusions:

Magnification endoscopy in combination with optical chromoendoscopy allows for a precise real-time assessment of histologic inflammation in IBD patients. Therefore, this approach holds the potential to reduce the need of physical biopsies for monitoring of inflammatory activity in patients with IBD during colonoscopy.